- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $3,955.04
| Facility | | $2,090.73 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.49 / $280.69 / $280.94
| Professional | | $192.49 | $280.69 | $280.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.48 / $293.50 / $490.08
| Professional | | $249.48 | $293.50 | $490.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.77 / $398.58 / $515.26
| Professional | | $190.77 | $398.58 | $515.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.80 / $351.70 / $541.19
| Professional | | $217.80 | $351.70 | $541.19 |